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Magnetic resonance imaging stereotactic target localization for deep brain stimulation in dystonic children
1Department of Pediatric Neurosurgery, University Hospital, Montpellier, France.
Insights
Magnetic resonance (MR) imaging distortions did not cause errors in stereotactic surgery for children with dystonia. This MR imaging-based method allows accurate electrode implantation for deep brain stimulation.
Area of Science:
- Neurosurgery
- Medical Imaging
- Neurology
Background:
- Accurate targeting is crucial for stereotactic neurosurgery.
- Magnetic resonance (MR) imaging distortions can complicate precise surgical planning.
- Validating MR imaging-based methodologies is essential for stereotactic procedures.
Purpose of the Study:
- To validate an MR imaging-based methodology for stereotactic targeting of the internal globus pallidus.
- To assess the accuracy of MR imaging for electrode implantation in pediatric patients undergoing deep brain stimulation.
- To determine if MR imaging distortions introduce detectable errors in stereotactic surgery.
Main Methods:
- A cohort of twelve children with generalized dystonia underwent deep brain stimulation using a head frame and MR imaging.
- Geometrical accuracy of the head frame was verified using a phantom localizer.
- Pre- and postoperative coordinates of anatomical landmarks and electrode positions were statistically compared to evaluate MR imaging distortions.
Main Results:
- No significant differences were found between theoretical and measured dimensions of the MR imaging localizer.
- No significant differences were observed between pre- and postoperative coordinates of the anterior commissure (AC) and posterior commissure (PC).
- The AC-PC distance and the difference between preoperative target and final electrode positions showed no significant deviations, indicating high accuracy.
Conclusions:
- MR imaging distortions did not introduce detectable errors in stereotactic surgery for dystonic children in this study.
- MR imaging alone is sufficient for accurate target localization and electrode implantation after general anesthesia induction.
- The significant postoperative improvement in dystonia symptoms confirmed the procedure's accuracy.
Object:
The actual distortion present in a given series of magnetic resonance (MR) images is difficult to establish. The purpose of this study was to validate an MR imaging-based methodology for stereotactic targeting of the internal globus pallidus during electrode implantation in children in whom general anesthesia had been induced.
Methods:
Twelve children (mean follow up 1 year) suffering from generalized dystonia were treated with deep brain stimulation by using a head frame and MR imaging. To analyze the influence of distortions at every step of the procedure, the geometrical characteristics of the frame were first controlled using the localizer as a phantom. Then pre- and postoperative coordinates of fixed anatomical landmarks and electrode positions, both determined with the head frame in place, were statistically compared. No significant difference was observed between theoretical and measured dimensions of the localizer (Student's t-test, ¿t¿ > 2.2 for 12 patients) in the x, y, and z directions. No significant differences were observed (Wilcoxon paired-sample test) between the following: 1) pre- and postoperative coordinates of the anterior commissure (AC) (deltax = 0.3+/-0.29 mm and deltay = 0.34+/-0.32 mm) and posterior commissure (PC) (deltax = 0.15+/-0.18 mm and deltay = 0.34+/-0.25 mm); 2) pre- and postoperative AC-PC distance (deltaL = 0.33+/-0.22 mm); and 3) preoperative target and final electrode position coordinates (deltax = 0.24+/-0.22 mm; deltay = 0.19+/-0.16 mm).
Conclusions:
In the authors' center, MR imaging distortions did not induce detectable errors during stereotactic surgery in dystonic children. Target localization and electrode implantation could be achieved using MR imaging alone after induction of general anesthesia. The remarkable postoperative improvement in these patients confirmed the accuracy of the procedure (Burke-Marsden-Fahn Dystonia Rating Scale score delta = -83.8%).